Medical truss and method of making same



Feb. 26, 1935. w. s. ROWLEY 1,992,397

MEDICAL TRUSS AND METHOD OF MAKING SAME Filed Feb. 9, 1932 Hi; if 7 In venfor. l W/l/am .S. Pow/e] IBJ @Horney.

Patented F eb. 26, 1935 PATENT OFFICE MEDICALTRUSS METHOD OF MAKING- William s. Rowley, Philadelphia, Pa. Application February '9, 1932, Serial No. 591,172

2 Claims. (01.128596) Heretofore it has been customary to make medical trusses for relieving patients who have ruptured conditions, the medical trusses being made with one .or more button-shaped pressure parts designed to be held by strong spring pressure upon the ruptured body portion in such manner as to prevent theprotrusion of the bowelor ligaments through the place of rupture. .The objection to medical trusses of that character. lies in the .fact that the retaining pressure of the button upon the weakened part of. the. body of the patient causes an abnormal inward pressure, which applies an excessive strain, such that, in some instances and by long usage, produce irritation. coupled at times with. enlargement of the rupture due to severe counter-action. Furthermore, where the pressurelis concentrated Wholly at the point of rupture, a very considerable spring pressure must be directlyapplied tothe wound and this is both undesirable and uncomfortable.

My invention has for its object the provision of a rupture padof much greater area than pads or buttons heretofore in use; and, moreover, my improved pad is so formed as to conform to the normal shape of the body surface of the patient about the rupture and for which the pad is .intended to be applied. To this end, the rupture pad in my improved medicaltruss is made or relatively large area and shaped to fit the body of the patient to a veryconsiderable extent about. and beyond the actualruptured portion and also to have that portion of the pad which supports the ruptured portion of thebody of a shape which largely corresponds to what is substantially the natural shape of the body of the patient and as it would be about. the rupture if there was no rupture or need of a truss. my improvement provides a structure for a truss padwhich has a supporting area whichcorresponds to the natural body about that portion which appliessustaining pressure to the injured or ruptured part of the patient and prevents said rupture supporting portion from being objectionably pressed inward against and through the ruptured portion of. the body.

My improved pad, therefore, is preferably counter-shaped in the main in conformity with the body surface about the rupture of the patient and as it would be if the patient had no rupture, and having only a moderate or smaller area shaped to the ruptured portion of the patient. The pad will largely support the rupturedbody partof the patient to maintain a position more nearly that which would be natural under ordinary healthy conditions, and in so doing, avoid undue andunnaturalstrains upon the ruptured body while permitting every opportunity for the ruptured portion to heal. l

With theabove and other objects in view, the

nature of which will be more fully understood In. other words,

from the following specification, the invention consists in the novel features of construction hereinafter more fully described and defined in the claims.

Referring to the drawing: Fig. l is adownwardly directed or plan view of a medical truss embodying my improvements; Fig.- 2 is a front view of the same; Fig. 3 is a perspective view of one of my improved rupture sustaining pads separated from the complete truss structure; Figs. 4 and 5 are horizontal sections of the pads and with body indications in broken lines to more fully indicate the nature of the pads as employed in my improved truss with the patient standing erect; Figs. 6 and 7 are vertical sections showing the making of the plaster casts from which to make the truss pads, whenthe patients are lying prone upon their backs; and Fig. 8 is a sectional viewof a flask in which to mold the final truss pad. H n V Y In the ordinary truss-in comrnonuse, the pressure is applied to such a small area as to permit the button to be objectionably forced inward of the body and thereby produce an unnatural support and one which will tendto bore into and increase thewound rather than'permit it tocure itself under natural conditions. In the making of my improvedpad, the best procedure is to make a temporary plaster cast or mold part of the injured body portion of thelpatient and from it prepare the final truss pad in vulcanite or other material. The following procedure is preferred:

It is understood that in making the mold the patient is lying prone upon his or her back. When in this position, the intestines, which have (when standing) protruded at C (Figs. 4 and 5)v from the upper and the lower, or from the internal and external abdominal ring, go back into place of themselves, and this leavesmore or less of a cavity C (Figs. 4, 5, 6 and '7), depending on the length of time'the patient has been ruptured,

in a position on the body directly in front of the external ring. When the mold is made, a portion of the substance used in making it finds its way into the cavity 0' of the body and hardens in this position. When the mold has hardened and is removed from the patient, the inverse of the full shape of the body at this point is transferred to the mold. The, mold thus made becomes the negative form from'which the truss appliance is to be made. The procedure is to make from this negative form a positive mold, and the appliance itself is molded into the positive mold. This, of course, makes the appliance shaped exactly like the negative mold, and, therefore, is a form fitting appliance which when attached to the patient must of necessity bring pressure to bear all air between the appliance pad and the body of the patient is excluded, thus inducing a suction, which of itself is sufficient to keep the appliance in place. The function of the springs 3-4, as a part ofthe appliance, is to furnish the necessary pressure to keep the external and the internal muscular abdominal rings closed, so that it is impossible for the intestines to work their way down through either ring. Because of the fact that the appliance itself is a form fitting instrument and remains in its place without movement on the surface of the body of the patient, there occurs a slight massaging treatment in which the whole structure of the wall is moved gently and this movement has a natural tendency to heal the broken tissues in both the external and internal abdominal ring, so that if attention is paid to the rupture in its early states, there is every chance that in a short time the patient will be able to discard the truss.

This extended plate pad, therefore, fits snugly to and over a much'greate'r portion of the body than that which is directly injured and the extended portion operates as a limit stop to the pressure of the plate into the ruptured body of the patient; In this manner, the definite surface position assumed by the pad is such that it may beconsidered as one against which the outward movement or tendency to movement of the ruptured portion may be received and held against .undue strain.

It will be understood that the pads will be of various shapes according to the parts of the body required to be supported, but in all cases the pad is shaped. to substantially fit the natural contour of the body beyond and about the rupture as if no rupture was present, and in that manner providea supplemental support for the ruptured portion which will not permit said ruptured portion to be pressed inward abnormally; and at the same timeby avoiding excessive pressure inwardly, by the truss upon the ruptured portion, abnormal re actionary or irritating outward pressure of the ruptured part is prevented, with the result that the inflammation is greatly reduced.

By wayjof exampla'my improved truss comprises the rupture pad portion 2 having inwardly directed sustaining surface portions 7 and 81, and combinedwith means for positioning and pressing the said pad portion 2 against the body of the patient and holding it thereupon, said latter parts being indicated .by the spring'portions 3 and 4, the positioning and holding pads 5, 5, and the tension strap 6 adapted to adjustably control the distance apart of the holding pads 5, 5, whereby said truss as a whole is supported upon the body of the patient as'indicated by the broken lines A and B illustrating the body of the patient on a horizontal plane in Figs. 4 and 5 immediately at or above the hips, and as more fully'indicated in'Fi'gs. 1 and 2.

In theconstruction shown, the rupture pad 2 is provided with metallic. extensions 9 which may be partly embedded in the materialof the pad (Fig. 1) and further secured thereto by screws or bolts 12 (Fig. 2), and to said metallic extensions 9 there are connected, by screws 3a, parts 3 of the spring metal portions 4, the latter curving about the hips and directed toward each other and at the back portion B'of the patient where they are provided with ordinary positioning and holding pads 5, 5, and coupled together by an adjustable flexible strap portion 6 provided with apertures adapted to engage headed pins 4a extendingloosely through the ends of the spring portions 4, 4. The tension of the springs 3 and 4 is preferably such as to impart a pressure upon the rupture pad and at the same time induce an upward rotation of the lower part of the pad 2 to cause a slight lifting efiect to be had. The particular construction of the springs and means for attachment of the truss to the patient are immaterial to my invention, so long as they cooperate to hold the rupture pad in definite sustaining position against the ruptured surface of the body. It will be understood that as the rupture pad 2 is largely shaped to snugly fit the natural contour of thebody, as it would be in health, and it will retain its position with a relatively small amount of actual. pressure produced by theaction of the springsB -4, forreasons' previously set forth. a 1

. Referring more particularly to the construction of the rupture pad '2, its general shape or peripheral contour may be varied to suit'the portion of the patients body'that is required to be sustained and protected; and by way of illustration, I have shown in Figs. 1, 2 and 3, a pad structure which'will extend somewhat across the abdominal portion so as to simultaneously'reach parts thereof on both the right and left portions of the pubic arch of the patient, as will readily be understood from Figs. 2 and 5. It will be observed that thispad is of relatively flattened form and having its contacting surface shaped as a counter-part to the shape of the 'body of the patient including the ruptured portion thereof with which it is to co-act.

In the making of the rupture pad 2, it is desirable to provide a plaster cast of that portion of the body to be occupied by the pad, such as would be indicated in Figs. 4, 5, 6 and '7, where the cross-hatched portion would represent a mass of plaster-Paris or other molding material, with the object of securing a mold from which the final truss pad 2 may be obtained. However, in making such a plaster cast, the surface thereof at the point 8 back of the protruding ruptured portion C of the body surface A, would produce in'the plaster cast a slight protuberance as a counter-form to the said rupturedv part when sunken into the abdominal rings when the patient is lying prone upon his or her back, as in Figs. 6 and 7. The'plaster cast, thus formed, would befas indicated at .7 and 8 in the diagrams Figs. 4 and 5.

After making thenegative form 7' by molding as above described, there is built upon it a positive plaster form 15 which is intended to be a positive reproduction of the surfaceformof the patient (Fig. 8). There is then builtupon this positive form 15 a wax form'16 giving to it all the shape which is to bein the final vulcanite truss plate 2. When this is done and with the metal plates 9 in position, if desired, there is built upon the wax form a third plaster form 1'7; The wax is then melted out of the flask and leaves a definite shaped space within the flask.

and 4, and holding pads 5, 5, for reaching around to the back of the patient and through their elasticity draw the rupture pad 2 snugly against the body of the patient, such as is indicated in Figs. 4, 5, wherein A, B, indicates a horizontal section of the body and C represents the protruding ruptured portion, and C the medium inward recess receiving protuberance 8 to press upon and seal the rupture openings.

Referring to Figs. 4 and 5 by Way of obtaining a clear understanding of the action of my improved rupture pad 2, it will be seen that where the protuding ruptured portion C occurs there will be at that place in the mold part 2 an inwardly protruding part 8 and this protuberance is materially less than the protuberance of the ruptured part 0 which, if unrestrained, would project considerably beyond the surface of the patient. It will be further noted that the inwardly directed protuberance 8 on the pad 2 is bounded by the surface 7 which constitutes an annular portion which perfectly fits to the patients body and limits the extent of the inward pressure by the, protuberance 8, said relatively small protuberance 8 being amply sufficient to cause the protruding bowel to be pushed back within the confines of the inner and outer abdominal rings, and thereby being prevented from working or boring into the inner and outer abdominal rings, and creating a gentle massaging effect which assists in healing the wound so that the patient may in due time be able to discard the truss, as hereinbefore pointed out. In this manner, the portions 7, '7, act as walls to be drawn against and in contact with unruptured portions of the patients body and thereby insure the positioning of the protubera'nt portion 8 of.

the pad, and will in this manner hold back the ruptured portion C of the body to a position which will put no undue strain upon the ruptured portion of the body. a It will further be observed that the part 8 acting upon the rupture and the parts 7, 7, acting as positioning walls for the part 8, are relatively continuous though provided with a somewhat sinuous surface shape. These particular shapes vary with different individuals and according to the positions of the rupture, and consequently each pressure pad 2 should be specially formed for individual patients where the best results are to be secured. It is possible, however, to make rupture pads of various shapes which approximately conform to the average requirements and these plate-like rupture pads may be further shaped by hand manipulation before final vulcanizing to make them more readily'adjustable to the needs of the patient, preliminary to said final vulcanization.

In Fig. 5, I have indicated my improved pad 2 as formed of perforated vulcanite material (13) for lightening the weight of the pad and at the same time providing for satisfactory ventilation.

While I have described the shaping of the unvulcanized plate to the surface 7, 8, '7, of what would be the molded form to obtain a substantially counter-form for the pad, it will be understood that after making a mold such as would be indicated in the cross-hatched parts of Figs. 4 and 5, a secondary mold plate may be made from said first mold and the vulcanite fiber shaped in conformity with the secondary mold, as in Fig. 8, but it is not thought that this extra requirement would be necessary in many cases. As, however, it is desirable that the first mold part 2 shall be made of a plastic material which will readily flow and thus shape itself upon the body of the patient and quickly harden, it is preferable for accuracy that the first mold part 2 be formed in this manner and when set and hardened it be employed as a form from which other mold parts of tougher or stronger material may be made,

the final of which parts being made to conform in shape to the first mold part made of the plastic material directly from. the body surface of the patient.

I have shown my improvements more particularly as applied to a truss adapted toa rupture in the groin, but my improvements may be used about the lower body part or torso wherever a truss is needed, at front or back of thepatient, to counteract effects of weakness, strain, or rupture, as may be required.

I have described my improved method and product in that particularity which I deem to be the best exposition of my invention, and that which I prefer in commercial practice, but I do not restrict or confine myself to the minor or secondary details, as such are susceptible of modification, which may be resorted to as a matter of mechanical skill and without departure from the spirit of the invention. 7

Having now described the invention, whatI claim and desire to secure by Letters Patent is:

1. The herein described method of making a rupture pad for a medical truss, which consists in placing the patient in a reclining position whereby the protuberance of the rupture becomes by gravity a depression of less size than the protuberance of the rupture while the patient is in standing position, making a first mold portion upon and corresponding to the depressed ruptured partv of the body of the patient and continuing the molding to a considerable distance beyond and about the area of said-depressed ruptured part whereby it conforms to the relative position and surfacecontours of the patient at and about the ruptured part, thereafter molding upon said first mold portion a second mold portion having a conformation corresponding to that of the patient during the time of making of the firstmold part, and thereafter molding on the second mold portion the final shaped truss pad structure which conforms inversely to the surface contours of the patient and provides a more or less continuous flattened truss pad form having an inwardly directed rupture pad protuberance of less size than the normal protuberance of the actual rupture.

2. A self-supporting medical truss, comprising a relatively flattened rupture supporting pad having a surface contour shaped to the natural sur-' face contour of a patient and a substantially centrally disposed protuberance for directly sustaining the rupture, the supporting pad being extended radially about and beyond the protuberance to provide a substantially fiat sustaining surface inversely fitting to and resting upon the unruptured surface of the patients body immediately surrounding the ruptured portion thereof, in combination with supporting means for holding the rupture pad in suspension against the body of the patient, said supporting means comprising two oppositely arranged metallic portions rigidly secured to the supporting pad and having adjustable spring extensions also oppositely directed for imparting a lifting movement upon the pad, and pressure bearings secured to each of the rear ends of the spring extensions for causing upward pressure upon the pad and sustaining it in frictional contact with the body of the patient.

WILLIAM S. ROWLEY. 

